[George E. Vaillant] Adaptation to Life(b ok.org)

Adaptation to Life

Adaptation to Life
George E. Vaillant
With a New Preface by the Author

Harvard University Press
Cambridge, Massachusetts
London, England

This book is dedicated to the members of the Grant Study. Their
fidelity, their difficulties, and their solutions have inspired, touched,
and guided me for the past decade. My life is vastly richer for having
known them.

Copyright © 1977 by George E. Vaillant
All rights reserved
Printed in the United States of America
The epigraph on page 351 is from the play Equus by Peter Shaffer.
Copyright © 1974 by Peter Shaffer.
Reprinted by permission of Atheneum Publishers.


First Harvard University Press paperback edition, 1995
Library of Congress Cataloging-in-Publication Data

I.

Vaillant, George E., 1934Adaptation to life I by George E. Vaillant.
First Harvard University Press pbk. ed.
p. cm.
Originally published: Boston: Little, Brown, c1977ISBN 0-674-00414-0
Adjustment (Psychology)-Longitudinal studies. 2. Defense mechanisms
(Psychology)-Longitudinal studies. 3. Emotional maturityLongitudinal studies. 4. Adulthood-Longitudinal studies. I. Title.
BF335·V35
1995
95-3 161 4
QUNVセcRP@
CIP
Designed Uy Christine Benders

Acknow ledgments


T

he Grant Study of Adult Development was conceived in 1937 when
I was three years old. I did not join the staff until 1967. In writing
this book, then, I have harvested a crop that for three decades many
others have planted and devotedly tended. I am deeply indebted to the
foresight of William T. Grant, Earl Bond, M.D., and Arlie V. Bock,
M.D., for having planned the Study. I am equally indebted to Clark W.
Heath, M.D., who guided the Study for the first seventeen years of its
existence, and to the many social scientists, too many to list here, who
worked with him and helped him to gather its data. I am particularly
thankful to Lewise W. Gregory Davies, who is the only current staff
member who has been with the Study since the beginning; for almost
forty years she has provided the personal warmth that cemented living
men to the abstraction of a study of adult development.
Over the years I have enjoyed many teachers whose guidance indirectly has helped to shape this book. Among the most important are Lee
Robins, Peter Dews, Norma Haan, William Binstock, and most especially Elvin Semrad, who first conceived the hierarchy of defenses
described in this book.
Over the decade that I have worked on the Grant Study there have been

several men who have provided the intellectual climate and the institutional support needed to conceive, research, and write this book. My
patrons have been Bert Boothe of the Career Investigator Grant Program
of the National Institute of Mental Health and Douglas Bond and Philip
Sapir of the Grant Foundation. My patient chiefs of service, Paul Myerson
and then John Mack, and my institutional hosts, Dana Farnsworth, followed by Warren Wacker, have seen to it that I have had time and space in
which to be curious. (In more material terms, the Grant Foundation and
grants MH-I0361 and MH-38798 from NIMH provided financial support.)
There are many individuals who have helped me to write this book
even more directly: Some have helped as research associates and as

vi

Acknowledgments

independent raters (Jane Brighton, Nancy Sobowale, Charles Ducey,
Ana-Maria Rizzuto, Kenneth Robson, Eleanor Weeks, Henry Vaillant,
and Eva Milofsky).
Some have helped me as intellectual critics (Leon Shapiro, Leston
Havens, Norman Zinberg, Bennett Simon, John Mack, Jerome Kagan,
George Goethals, Henry Grunebaum, and Stuart Hauser).

Some have helped me as editors (Clark Heath, Suzannah Vaillant
Hatt, and especially Llewelyn Howland III of Little, Brown).
Phyllis Remolador deserves triple credit for serving both as a research
associate and as editor, and, together with Ronnie Ventura and Liv
Bjornard, uncomplainingly typing and retyping the myriad drafts that
this book has undergone.
Two other people deserve special gratitude for playing multiple roles.
The first, Charles C. McArthur, was director of the Study from 1955 to
1972. Without his devotion the Study might not have survived to maturity.
Not only did he gather much of the data that comprise the Study, but also,
in welcoming me into his "laboratory" and generously providing counsel
and help, he created a climate in which my own efforts could prosper.
Charles McArthur achieved the most difficult and the most selfless task of
a mentor: he allowed me to feel that a work that would have been impossible without his help was my own creation.
The second is my wife, Caroline Officer Vaillant. Over the years she
has made an invaluable contribution to this book as research associate and
intellectual critic and editor. She has always shown an uncanny ability to
ask the right questions and for years she has made time present the very
best part of my life cycle.
Only the Grant Study men themselves have made a more critical

contribution to the birth of this book.

Contents
Preface, 1995
Cast of Protagonists

ix
xiv

PART ONE: The Study of Mental Health:
Methods and Illustrations
Introduction
Mental Health
2. The Men of the Grant Study
3. How They Were Studied
4. Health Redefined-The Joyful Expression of Sex
1.

and of Anger


PART TWO: Basic Styles of Adaptation
5.
6.
7.
8.
9.

Adaptive Ego Mechanisms-A Hierarchy
Sublimation
Suppression, Anticipation, Altruism, and Humor
The Neurotic Defenses
The Immature Defenses

PART THREE: Developmental Consequences of Adaptation
The Adult Life Cycle-In One Culture
II. Paths into Health
12. Successful Adjustment

ID.


3
13
30
41

53
73
75
91
ID5

127
158
193
195
237
259

viii


Contents

13· The Child Is Father to the Man
14· Friends, Wives, and Children
PART FOUR: Conclusions

IS· The Maturing Ego
16. What Is Mental Health-A Reprise
IJ· A Summary
References Cited
Appendix A: A Glossary of Defenses
Appendix B: The Interview S.chedule
Appendix C: The Rating Scales

28 4
30 3

327
329
351

368
376
383
387
389

Tables and Figures
Table I-Responses to a Questionnaire at the Twenty-fifth College Reunion
36
Table z-Schematic Table of Adaptive Mechanisms
80
Table 3-A Comparison between Men Who Used Mature Adaptive Mechanisms
87
and Men Who Used Immature Adaptive Mechanisms
Table 4-Dramatic Differences between the Best and Worst Outcomes
z75
Table 5-Comparison of the Adjustment of the Lonely and Friendly Men
306
Table 6-Comparison of the Adjustment of Men with Good and Bad Marriages 3Z4
Table 7-Differences between Best and Worst Outcomes Relevant to an

Eriksonian Model of the Life Cycle
350
Figure I-Composite Pattern of Defense Distribution between the Best and
the Worst Outcomes
Figure z-Shifts in Defensive Styles During the Adult Life Cycle
331
Figure 3-Shifts in Defensive Styles During the Adult Lives of Perpetual Boys 333
Figure 4-Shifts in Defensive Styles During the Adult Lives of Generative Men 334

Preface, I995

O

ver the last twenty years, this book-which I had such fun writinghas played very differently to different audiences. To my surprise,
the reviewer for the Wall Street Journal loved it and the reviewer for
Contemporary Psychology did not, writing that "psychologists scientifically or professionally concerned with human development will find little
in the way of evidence or insight in Vaillant's offering." To my immense
gratification, long-term follow-up has suggested that he was quite wrong.
Despite the predictions of the reviewer, the book continues to be widely
cited in the scientific literature.

One major concern of many reviewers, however, and indeed of myself, was that this book reviews only the lives of an elite group of
men. Do the findings of the book generalize to more diverse groups?
For example, one woman wrote to me: "I am so full of feelings and
thoughts I feel compelled to write you a letter. Although I found that
in essence I agreed with the conclusions, and thought the book clear
and interesting, I kept getting angry. The first thing that made me
angry [was] the objective criteria used to classify men as best outcomes, worst outcomes, or somewhere in between. I know you apologize and explain them throughout the book, but they are pretty elitist
and class bound ... "
Since Adaptation to Life was written I have had the opportunity and
privilege of studying the life courses of two contrasting groups-a
cohort of very underprivileged inner-city men first studied by Sheldon
and Eleanor Glueck and a group of gifted women first studied by Lewis
Terman and, later, by Robert Sears. The results from both groups, each
of which was studied prospectively for more than half a century, have
confirmed this book's general premises. First, not only was maturity of
defenses important to the mental health of all three groups, but such
maturity did not appear to be the product of social class, education, or
gender. The undereducated inner-city men did not seem less capable of

x

Preface, I995

mature ingenious adaptation than did the Harvard graduates described in
this book. And, contrary to all my expectations, the most popular defensive styles of the Harvard men were the same as those styles deployed
by the gifted women and the inner-city men.
Second, the Eriksonian stages of development described in Chapter IO
apply not only to the Harvard men but also to the gifted women and the
inner-city men. In short, not only mature defenses but also generativity
and career consolidation are distributed more equitably within the
American population than are advantages that accrue simply as a result
of social class or gender bias. (These findings have been published in
Wisdom of the Ego, Harvard University Press.)
Over the years, I have also been gratified by the fact that Adaptation to
Life, even when it provoked the reader, also brought real pleasure. Thus,
the same woman who took me to task for my biases three pages later
closed her letter: "Oh well, end of my thoughts. What enormously exciting work you do. And thank you for writing the book. I haven't been so
stimulated in a long time. If I take issue with a number of things, it's
only because the book made me feel as if I were having a long discussion
with an old friend."
Since this book was published, the Grant Study men themselves
have helped me to put some of its strengths and weaknesses in perspective. One of the book's great weaknesses-and great strengths-is
the degree to which it depends on the courage and generosity of the
study members in granting me permission to study them without proper recompense and to publish facets of their lives even when these
have been painful. For example, one man felt with understandable bitterness that he had "been exploited for research for others' aggrandizement," and he said that he felt I had watched him as "a poor specimen wiggling underneath the microscope." The wife of another man
shouted at me over the telephone, "You sit back watching a man dying
of alcoholism ... and do nothing." Yet both men have continued to
contribute to the Study.
Over the last twenty-five years, of course, there have been many times
when the men appreciated being under the microscope. There have also
been times when I and the Study have been able to make meaningful and
helpful interventions in their lives. Some interventions have been direct,
others indirect. For example, one Study member wrote in response to the
copy of Adaptation to Life that I sent him:

Preface, I995

xi

It had a curious effect on me. Although I was not one of the
sample on which the book was based, your book put me in a
singularly confessional mood ... But I will suppress most of
this confessional impulse, with one exception, which has to do
with the more specifically therapeutic value of your book for
me ... Reading your book led me to see a connection between
the difficulty with my father and my reaction to visible success.
The insight is not itself a very happy one; but somehow I feel
vastly better for having reached it, and I am deeply grateful for
your contribution to it. I like to think that it may give you
some satisfaction to know that, even in your scientific work,
you are providing direct psychiatric care.
Over the years, with his characteristic generosity toward young
authors, Alan Poe, the last-and most dramatic-protagonist in the
book, wrote me several letters. Let me offer excerpts from two: "When I
got to the end of the section you sent, I had tears in my eyes. I finally
made my point. Or, more properly, you made it for me with a quiet eloquence that, as a writer, I can only envy."
Five years later in response to my continued concern that Poe's use
of alcohol was out of control and threatening both his creativity and his
health, he put my concern into perspective: "Thank you for your letter
of August 7th. Its great good will caused my eyes to fill. I appreciate
the concern, and take it seriously ... After getting your letter, I went
back and read your report of our interview way back in I975. In it you
wrote, 'I felt that Poe was stalked by death, suicide and skid row. ",
[Next Alan Poe pointed out to me that during the five years following
my gloomy prognosis, he had published three novels and created two
successful off-Broadway plays.] "Now, of course," he continued, "the
prognosis of death is a pretty sure bet. I am 61 years old. Hell, I could
be dead by the time you get this letter. But if I am, let it be published in
Gath that-especially in the last 5 years-I sure squeezed that lemon!"
A paradox.
Two years later Alan Poe died-much beloved and much mourned by
a great many people. True, his death was the consequence of a senseless
accident sustained in the middle of the day when he was very drunk. But
when he died, he was sixty-three. His life had been full; his death had
been painless; and he had sure squeezed that lemon.

xii

Preface, I995

Mr. Goodhart, the book's first protagonist, was also concerned with
the paradoxes of studying mental health. After reading the book, he
wrote to me:
Poe's remark about Goodhart's apparent lack of celebratory
zest made me chuckle; I must admit that the sketch of Goodhart
struck me somewhat the same way. I did share Poe's reservation
about the seeming lack of connection between social values
and mature adaptation. Approval of Joe McCarthy and Nixon,
... unquestioning acceptance of the inequities of the status
quo-these and like attitudes are hard for me to reconcile with
emotional maturity. They seem to me more in keeping with
your definition of projection. The issue is not liberalism versus
conservatism, but the disparity between public and private manifestations of empathy and humaneness ....
I wondered if you shouldn't have put more emphasis on the
contradictions, ambivalences, and ambiguities that co-exist
with our dominant psychological traits ... Your analysis seems
to suggest that the preservation of any marriage, whatever its
quality, is a positive indicator. This doesn't seem to me consistent with my experience and that of some friends. My conviction, in retrospect, is that I would have shown greater emotional maturity and enhanced my personal growth if I could
have brought myself to terminate my first marriage a good
deal earlier than I did. The pleasure and fulfillment of my second marriage have strengthened that conviction. As I look
back on it, hanging onto a troubled marriage kept me constantly in battle against feelings of guilt and lack of selfesteem, drained off energy, and interfered with my relationships with my children.
I also hope to read an equally fascinating sequel one day.
It is now 1995 and so much has changed since I first met these men at
their twenty-fifth reunions. When I first got to know them, I was a thirtythree-year-old just beginning to know what I wanted to do with my life
and filled with the dissociation and reaction formation of youth. They
were the seasoned fathers of adolescents and at the height of their occupational powers. I was awed by their willingness to tolerate and discuss

Preface, I99S

xiii

depression, and I marveled at the breadth of their power in the real
world. Now my own career has been consolidated through studying
their lives. I am now a grandparent and many of them are great-grandparents. I have reinterviewed a number of them at their fiftieth reunions
and have noted that perhaps some of their "power" was a product of my
youthful idealization. I am far more at peace with the fact that grief is
part of the human condition-to be faced, expressed, and not denied. I
am working hard to understand and to put in perspective their "adaptation to aging." As they once made me look forward to life after Harvard,
they now make me look forward to life after seventy. Oh, and yes, the
book that Mr. Goodhart requested is in preparation, but its publication is
a few years away.
April 1995

Cast of Protagonists
Chapter I
David Goodhart - Son of prejudiced Detroit blue-collar worker; consultant to Ford Foundation for urban affairs. Adaptive style: altruism,
humor, sublimation, and suppression.
Carlton Tarrytown, M.D. - Florida ear, nose, and throat specialist;
lonely; Lotus-eater; an alcoholic with a poor childhood. Adaptive
style: dissociation and projection.
Chapter 4
Frederick Lion -New York magazine editor who used anger creatively.
Adaptive style: sublimation.
Horace Lamb-Retired single ex-diplomat and book collector. Adaptive
style: fantasy.
Casper Smythe, M.D. - University health service physician with two
divorces and a not always satisfactory sexual adjustment. Adaptive
style: repression and passive aggression.
George Byron, Esq. -Government AID lawyer who had an excellent
marriage and a very satisfactory sexual adjustment. Adaptive style:
dissociation, anticipation, suppression, and sublimation.
Chapter 6
Lieutenant Edward Keats - World War II combat pilot; subsequently an
unhappily married social worker. Adaptive style: sublimation, reaction
formation, and passive aggression.
Professor Dylan Bright - Pugilistic professor of poetry. Adaptive style:
sublimation and dissociation.
Professor Ernest Clovis - Professor of medieval French whose wife,
then his daughter, became chronically ill. Adaptive style: sublimation
and suppression.

Cast of Protagonists

xv

Chapter 7
Mayor Timothy Jefferson-Long Island politician whose daughter had
cystic fibrosis, and who struggled to master anger. Adaptive style:
suppression, anticipation, and altruism.
Dr. Jacob Hyde - A pharmacologist with a hypochondriacal mother;
he beat swords into plowshares. Adaptive style: reaction formation
and altruism.
William Forsythe - State Department troubleshooter. Adaptive style:
anticipation.
Richard Lucky - The prototype of a happy childhood and a happy
marriage; ran two corporations during the week and six miles on the
weekend. Adaptive style: suppression.
Eben Frost, Esq. - Vermont farmboy turned successful corporate lawyer.
Adaptive style: suppression.
Chapter 8
Richard Lucky- Introduced in Chapter 7.
Richard Stover-Basketball captain who for years never had a date but
who became a warm husband and father. Adaptive style: repression.
Dean Henry Clay Penny - Parsimonious, superstitious college dean.
Adaptive style: intellectualization.
Samuel Lovelace-Lonely, gentle, loyal liberal with an unhappy marriage
and few social supports. Adaptive style: intellectualization.
Russell Lowell, Esq. -Boston lawyer and Stoic. Adaptive style: intellectualization and suppression.
Vice-President Richard Fearing - Computer magnate with multiple
fears as a child and conversion symptoms as an adult. Adaptive style:
displacement.
Judge Conrad Spratt-Chicago probate judge who grew up in Manchuria and suffered osteomyelitis. Adaptive style: reaction formation.
George Byron, Esq. -Introduced in Chapter 4.
Carlton Tarrytown, M.D. - Introduced in Chapter I.
Chapter 9
Harry Hughes - Trade book editor who as a child learned initiative
could be dangerous, and who experienced a prolonged adolescence.
Adaptive style: projection and reaction formation.
Francis Oswald - Virtuous as a marine, too strict as a father, and gallant as

xvi

Cast of Protagonists

a defender of the Florida Everglades. He suffered a serious depression.
Adaptive style: reaction fonnation, projection, and delusional projection.
Harvey Newton-Lonely but famous physicist who built an institute to
solve the riddles of the universe. Adaptive style: fantasy.
William Mitty-Lonely astronomer who joined the Oxford movement as
a young man. Adaptive style: fantasy.
Robert Hood-Promiscuous alcoholic who almost became a child batterer and instead became a celibate student of T.M. Adaptive style:
projection and acting out.
John Hart- Brilliant mathematician who developed heart pains after his
father died of a coronary thrombosis. Adaptive style: hypochondriasis.
Lieutenant Edward Keats-Introduced in Chapter 6.
Thomas Sawyer- Rockefeller campaign aide who first was bullied by
his mother and then by his wife. Adaptive style: passive aggression
and displacement.
Chapter IO
Robert Jordan-A college conservative who became a fifty-year-old liberal.
Adam Carson, M.D. - Harvard physician who turned from research to
clinical practice and illustrated the stages of the adult life cycle.
Oliver Kane-Orphaned corporate executive with mature ego defenses
and a barren personal life. Adaptive style: intellectualization, suppression, and humor.
Mayor Jefferson - Introduced in Chapter 7.
Harry Hughes-Introduced in Chapter 9.
Chapter II
Robert Brooke-A sensitive bombardier who cured a wartime neurosis
through poetry. Adaptive style: evolution from repression and dissociation to sublimation.
James O'Neill, Ph.D. -Boston economist and statistician with happy
childhood; for years was diagnosed as an "inadequate personality"
due to chronic alcoholism, then recovered. Adaptive style: evolution
from reaction formation and intellectualization to passive aggression
and acting out, which in turn evolved into sublimation and altruism.
Francis DeMille - Hartford advertising man who when young was
dependent on his mother and oblivious to women, but who matured

Cast of Protagonists

xvii

into a competent husband and father. Adaptive style: evolution from
repression and dissociation to sublimation.
Herman Crabbe, Ph.D. -An industrial chemist who matured through a
fortunate marriage, from an eccentric scientist, overwhelmed by a mentally ill mother, into an effective leader of a research team. Adaptive
style: evolution from projection and fantasy to displacement.
Godfrey Minot Camille, M.D. - A dependent, hypochondriacal, and suicidal medical student who through prolonged medical and psychiatric
treatment became an independent and giving physician and father.
Adaptive style: evolution from hypochondriasis through displacement and reaction formation into altruism.
Chapter 12
Steven Kowalski - Ebullient businessman who made a success of life
and a virtue of aggression. Adaptive style: suppression.
Leslie Angst-Harried banker who drank too much, worried about
his chronic failure, and did not enjoy his marriage. Adaptive style:
displacement.
Chapter 13
Samuel Lovelace-Introduced in Chapter 8.
William Lucky-Introduced in Chapter 8.
Oliver Kane-Introduced in Chapter 10.
Chapter 14
Francis Oswald-Introduced in Chapter 9.
Chapter IS
William Forsythe-Introduced in Chapter 7Adam Carson, M.D. -Introduced in Chapter 10.
Chapter 16
Alan Poe - San Francisco poet, thoughtful conscientious objector and
empathic iconoclast who illustrated that mental health is not simple.
Adaptive style: sublimation.

Part I
The Study of
Mental Health:
Methods and
Illustrations

Introduction
There are thousands of studies of maladjustment for each one that deals directly
with the ways of managing life's problems
with personal strength and adequacy.
- Lois Murphy, The Widening World
of Childhood

I

n 1937 a philanthropist, William T. Grant, met with the director of a university health service, Arlie V. Bock, M.D., and
together they decided that medical research was too weighted in
the direction of disease. They agreed that "Large endowments
have been given and schemes put into effect for the study of the
ill, the mentally and physically handicapped .... Very few have
thought it pertinent to make a systematic inquiry into the kinds
of people who are well and do well."l As a result, the philanthropist and the health service director agreed to select a small
but healthy sample of several consecutive college classes for intensive medical and psychological study. Thus, there came into
being a cohort of men who were chosen for study because they
seemed healthy. This book will describe their lives over the
thirty-five years that followed. The men of the Grant Study, as it
came to be called, did not all live happily ever after, but their
experiences have meaning for us all.
In a somewhat similar study, Frank Barron, a University of
California psychologist, had studied healthy graduate students in
great detail. A major conclusion of his investigation was that "no
especially blessed individual turned up in this assessment; the
luckiest of the lives here studied had its full share of difficulty and
private despair .... The conclusion to which the assessment
study has come is that psychopathology is always with us and
soundness is a way of reacting to problems, not an absence of
3

4

The Study of Mental Health: Methods and Illustrations

them."2 His conclusion will become the dominant motif of this
book.
At the time that they were chosen for special study, all of the
men in the Grant Study had achieved good academic standing in
a highly competitive liberal arts college. Most of the men selected
subsequently rose to the rank of officer and made distinguished
records for themselves in the less academic atmosphere of World
War II. There they were judged for skills other than intellectual
achievement. Three decades later, as they pass their fiftieth
birthdays, most are still alive and without disabling physical
illness. Over ninety percent have founded stable families. Virtually all have achieved occupational distinction. Yet there is not
one of the men who has had only clear sailing. Thus, over the years
the focus of the Grant Study became how men adapt to life.
In his 1937 monograph, Ego Psychology and the Problem of Adaptation, Heinz Hartmann suggested that health and adaptation
were inseparable. "The concept of adaptation," he wrote,
"though it appears simple, implies ... a great many problems.
The analysis of this concept promises to clarify many problems of
normal and abnormal psychology, among them our conception of
mental health."3 Hartmann was quite unaware of the Grant
Study, and although his monograph eventually became a cornerstone of modern psychoanalytic thinking, the Grant Study
staff were quite unaware of Heinz Hartmann.
At the time the Grant Study began, the staff consisted of internists, psychiatrists, psychologists, physiologists, and anthropologists. As specialists, these men recognized that each of
their disciplines had been distorted by its focus upon the deviant
or exceptional members of human society. The Study staff members were determined to pool their efforts and examine a group of
healthy young men. In the mid-1940s, the first two books on the
Study were published. What People Are by Clark Heath and Young
Man, You Are Normal by Ernest Hooton provided few surprises. 4
These early publications were designed to summarize research
already accomplished, and this they did. But even at the time, the
original investigators realized that publication was premature.
Hooton warned, "For one thing, it is not enough to cut two or
three small cross-sections out of the young manhood of a tiny
sample of our species; they must be watched and studied through

Introduction

5

their entire careers."5 In the first year after its bottling, you cannot savor the true quality of a fine Bordeaux.
Thirty more years have passed, and the men continue to participate in the research with astonishing loyalty. As they have
grown in stature, their study has become progressively more fascinating. The subjects have become bestselling novelists and
cabinet members, scholars and captains of industry, physicians
and teachers of the first rank, judges and newspaper editors. Yet
all have displayed in abundance what Freud called the
psychopathology of everyday life.
This attempt of mine to describe how these men adapted to life
is a presumptuous task, and one beset by myriad difficulties. The
greatest pitfall is that I try to suggest that some behaviors are
"healthier" than others. Yet all definitions of health - especially
of mental health - are relative. I have taken the position that
since good health can get worse but not better, "average" or
"normal" has no place in its discussion. Average eyesight, average life expectancy, even average 1.0. reflect the average amount
of disease and incapacity present in the population. By definition,
then, "healthy" will not be "average."
But from whose vantage point should mental health be judged?
Mental health may be considered from the subjective viewpoint
of the individual being studied (i.e., feeling good) or from the
point of view of the group (Le., nondeviant). But if "health" is
judged by group consensus, then which group determines what
consensus? "Health" can also be defined from the point of view of
the ciinician (that anything is healthy that does not interfere with
the objective well-being of the organism). But then, as the
psychoanalyst Edward Glover has suggested, cannot health
merely be a form of madness that goes unrecognized because it
happens to be a good adaptation to reality? Glover suggested an
alternative measure of health, "behavior unaffected by conflict";6
but cannot healthy behavior be the result of ingenious response
to conflict? The possibilities for debate are endless.
To pose the question differently, what facet of a person's life
should we examine in order to find health? Certainly, the more
sophisticated and sensitive we become, the more unmeasurable
become our criteria. Frank Barron's early studies of creativity
postulated that healthy persons should manifest such traits as "a

6

The Study of Mental Health: Methods alld Illustrations

sense of humor," "personal courage," "a certain innocence of
vision and spontaneity of action," "honesty of thought," "social
responsibility," "acceptance of the past and no fear of the future," and finally, a capacity "to be able to contribute something
of human love to the world."7 I heartily agree with such criteria,
but in what units do you measure them? Unfortunately, ideal
definitions cannot be systematically applied to real people. Like
beauty, the perception of such abstractions too often lies in the
eyes of the beholder.
In providing mankind with a working definition of mental
health, Leo Tolstoy, a patron saint of the counterculture, had
anticipated Sigmund Freud's middle-class concept of lieben und
arbeiten by half a century. Freud was only six months old when
Tolstoy advised his almost-fiancee, Valery Arsenev, "One can live
magnificently in this world, if one knows how to work and how to
love, to work for the person one loves and to love one's work."8
One of the soundest men in the Study agreed with Tolstoy; he
wrote, "I am enthusiastic about the future because I have a good
business to work at and a good family to work for." Another
Grant Study member suggested that health could be estimated
from a person's "dealings with other people." He believed that a
healthy man would succeed in "reaching his own goals and helping those around him to reach theirs," while a misfit's life would
consist of" making more enemies than friends and frustrating his
own desires."
Rather than becoming bound to any rigid definition of health, I
prefer to align myself with Roy Grinker, Sr., a psychiatrist who
has contributed significantly to our understanding of psychological health. He suggested that "the articles and books written on
[health] are numerous but highly repetitive .... Most of the discussions are theoretical and conceptual and ... without operational referents."9 So, adhering both to Grinker's suggestion and
to Barron's quotation that "Soundness is a way of reacting to
problems, not an absence of them," I will confine myself to a discussion of concrete aspects of adaptation. In this book "health"
will be defined in terms of objective clinical evidence. Men will be
considered well adapted in terms of the number of areas in which
they function well, rather than in terms of excellence within a
special area. Finally, what a man does will be given more cre-

Introduction

7

dence than how he says he feels: the robust hypochondriac, in
this sense, will be considered healthier than a Christian Scientist
who denies his brain tumor. Nevertheless, I hope to show that
what humans do and how humans feel are closely related.
Because an introduction permits the writer certain liberties, I
shall use it to orient the reader further to my theoretical bias.
Since the focus of the Study is upon adaptation to life, much
attention will be devoted to ego mechanisms of defense. Often
such mechanisms are analogous to the means by which an oyster,
confronted with a grain of sand, creates a pearl. Humans, too,
when confronted with conflict, engage in unconscious but often
creative behavior. These intrapsychic styles of adaptation have
been given individual names by psychiatrists (projection, repression, and sublimation are some well-known examples). The
generic term for such adaptive styles as a class is ego mechanisms
of defense. In such context the word ego represents a reification of
the adaptive and executive aspects of the brain. In this book the
so-called defense mechanisms of psychoanalytic theory will often
be referred to as coping or adaptive mechanisms. This is to underscore the fact that defenses are healthy more often than they
are pathological. I shall be discussing defenses as actual behaviors, affects, and ideas which serve defensive purposes, rather
than as theoretical constructs that attempt to describe mental
functioning. Throughout, I shall try to infer what goes on inside a
man by what can be outwardly observed. In reviewing modern
approaches to the mind, Leston Havens points out that the
objective-descriptive mode is not the only approach to the
mind,lo but it is the one that I have chosen.
At first the reader may find both my concepts and my nomenclature of adaptive mechanisms arbitrary and difficult. (To
many, the birds that touch down at a feeder look remarkably
alike, and their alleged classification seems unnecessary. But by
attending to examples and permitting experience to accumulate,
the observer gains pleasure and mastery by perceiving that
nuthatches are truly different from chickadees.) I must acknowledge from the start, however, that defenses are far less tangible
than birds. Indeed, the so-called ego mechanisms are metaphors,
not biological species or pieces of clockwork. Readers should feel
free to substitute their own taxonomy. What must be kept in

8

The Study

of Mental Health: Methods

and Illustrations

mind, however, is that some sort of shorthand is needed to describe mental processes. I have found the metaphorical language
provided by psychoanalysis to be serviceable.
In writing of mechanisms of adaptation, I am not writing about
conscious avoidance of problems, or about willpower, nor do I
mean perseverance or turning to others. These all serve as a
means of handling problems; rather I am discussing a far more
subtle and almost entirely unconscious process. Indeed, the ego
mechanisms of adaptation went unrecognized until described by
Sigmund Freud in his earliest psychiatric papers of 1894-1896. 11
Today, the majority of recent college graduates would probably
recognize several of the following terms: sublimation, projection,
repression, reaction formation, and displacement. Many could
probably cite an example in the behavior of a perfectly healthy
friend. But before the twentieth century, awareness of such
mechanisms did not exist. Like the curvature of the earth, adaptive mechanisms have been always in view, but someone had to
point them out before everyone could notice them.
Let me give a concrete example of unconscious adaptive behavior. A California hematologist developed a hobby of cultivating living cells in test tubes. In a recent interview, he described
with special interest and animation an unusually interesting culture that he had grown from a tissue biopsy from his mother.
Only toward the end of the interview did he casually reveal that
his mother had died from a stroke only three weeks previously.
His mention of her death was as bland as his description of the
still-living tissue culture had been affectively colored. Ingeniously and unconsciously, he had used his hobby and his special
skills as a physician to mitigate temporarily the pain of his loss.
Although his mother was no longer alive, by shifting his attention
he was still able to care for her. There was nothing morbid in the
way he told the story; and because ego mechanisms are unconscious, he had no idea of his defensive behavior. Many of the
healthiest men in the Study used similar kinds of attention shifts
or displacement. Unless specifically looked for by a trained observer, such behavior goes unnoticed more often than not.
Another example of the ego's ingenuity was offered by a very
gentle, idealistic lawyer. As a young man he had been bullied by

Introduction

9

his wife into taking divorce cases because such cases were so
profitable; but when he came home at night from his work, the
maid would often tell him his wife was out and that no supper
had been prepared. Gradually, he realized that she had been
going to the Lake Tahoe casinos with a boy friend whose gambling habit the lawyer was supporting. When I asked him what he
did with his anger, he replied, "I tried to sweep it under the rug. I
pretended it wasn't there." I waited for what else he might add.
He was silent a moment; and, then, in an offhand manner he told
me that he would often spend such evenings with an amateur
theatrical group whose mission it was to put on comic plays. "It
was a place people could sublimate in. It was sort of a family
substitute." In this way, he was able to dissociate himself from his
rage. The overt behavior of both the lawyer and the physician did
not seem out of the ordinary to them, but their behavior did
appear decidedly unusual to the outside observer. Such unconscious behavior allows us to go on about life's business without
anxiety or depression - the overt hallmarks of intrapsychic
conflict.
The reader may scoff at these examples and wonder how they
could occur in the lives of healthy people. But ego mechanisms of
defense imply a dynamic restorative process, and by no means
connote the abnormal. Rather, defenses have much in common
with the behavior of an opossum vigorously and alertly playing
dead or with a grouse seeming to nurse a "hurt" wing in order to
protect her babies. Such smoothly functioning actions are a sign
of health.
By analogy, for centuries fever and pus were synonymous with
disease, yet they are actually the body's adaptive response to
invading bacteria. If complications do not occur, such responses
are normal; it is the external infection that is unusual. So it is
with ego mechanisms; they are normal responses to abnormal
circumstances.
In more formal terms, ego mechanisms of defense describe unconscious, and sometimes pathological, mental processes that the
ego uses to resolve conflict among the four lodestars of our inner
life: instincts, the real world, important people, and the internalized prohibitions provided by our conscience and our culture.

IO

The Study

of Mental Health: Methods and Illustrations

Conflict may arise between just two or among all four of these
sources of human motivation. Usually, ego mechanisms are
employed:
to keep affects within bearable limits during sudden
life crises (e.g., following a death);
2. to restore emotional balance by postponing or channeling sudden increases in biological drives (e.g., at
puberty);
3. to obtain a time-out to master changes in self-image
(e.g., following major surgery or unexpected promotion);
4. to handle unresolvable conflicts with people, living or
dead, whom one cannot bear to leave (e.g., the
lawyer's wife, the hematologist's mother);
5. to survive major conflicts with conscience (e.g., killing in wartime, putting a parent in a nursing home).
I.

The psychologically sophisticated reader may balk at my use of
the theoretical construct - ego mechanism of defense - to describe overt behavior. Such critics will be right if they say that I
am really writing about adaptive styles rather than "mental
mechanisms." But in turn, I remind them that the chronology of
the book covers a lifetime and not a therapeutic hour. How long
must a "mental mechanism" last before it affects life-style? Besides, the life study of adults may offer the investigator data similar in nature to what a child psychiatrist observes during play
therapy. Because of their relatively high intelligence and education, the men in the Grant Study had a great deal of freedom in
regard to both career choice and life-style. Thus, by the age of
fifty, many of the men in this Study were in idiosyncratic careers
of their own devising. These were often careers in which the men
had to answer only to themselves and which had been in part
shaped to solve conflict. As a student of their behavior, I knew
little of the subjects' dreams, their unconscious fantasies, their
slips of the tongue; but I knew a great deal about what they did
with their lives.
Judging a man by his behavior rather than by what he says or
feels is, of course, a perilous business. Nevertheless, it is easier to

Introduction

II

handicap a horse on his track record than by careful scrutiny of
his appearance in the paddock. Similarly, by paying attention to
a person's external behavior, it becomes much easier to validate
clinical judgment. In looking for and interpreting adaptive styles,
error is bound to occur and personal bias to show. In part, trying
to fathom the adaptive purposes of unexpected behavior is like
trying to interpret Rorschach inkblots - one's own projections
take over. But the study of lifetimes protects the observer from
many biases. For example, with Van Gogh's whole life before us,
it is not hard to gain consensus of personal judgments of both his
genius and his mental anguish. Van Gogh may be judged gifted
because his paintings brought the world great pleasure, as evidenced by their sustained popularity and current cost; and he
may be considered depressed and angry because he was psychiatrically hospitalized and he cut off his own ear.
Let me anticipate three criticisms. First, while describing the
adaptive maneuvers of these men, I was repeatedly reminded
that their lives were "too human for science, too beautiful for
numbers, too sad for diagnosis, and too immortal for bound journals." Human beings need science. But science never does human
beings justice. The Grant Study subjects deserve better than to be
regarded as guinea pigs.
Second, I am a clinician, and the men's lives have been discussed with clinical candor. Any resemblance between the examples in this Study and persons living or dead is entirely intentional. However, I have deliberately selected examples that
describe more than one memberofthis Study and, I hope, describe
many others outside of it. I have taken pains to camouflage the
actual details of the subjects' lives. If the clinical detail fits anyone
of the reader's acquaintance too closely, anyone who might have
been in college in 1940, it will almost certainly tum out that he
has identified the wrong man. Even when the Study members
recognize themselves, I suspect that they will be wrong as often
as they are right; but I hope that through identifying they learn
something worth knowing. (All the case histories presented in this
book have been reviewed by the living protagonists and they
have granted me permission to publish the disguised narratives.)
Third, the fanciful names like David Goodhart and Horace
Lamb, assigned to the subjects, are neither intended to be face-

12

The Study

of Mental Health: Methods and Illustrations

tious nor to make sport of human foibles. Rather, my intent has
been to permit a busy reader to remember individual examples
from one chapter to the next. Designations such as "Case I" or
"Dr. C.R." would be useful in a short paper, but not in a book.
Finally, let me offer a fourth caveat. This book is written
through my eyes, through my limited experience, and must in
part reflect the distortions of my own adaptive mechanisms.
Readers are welcome to do their own editing, or, if they wish, to
theorize about my own prejudices and adaptive distortions.
In order for the reader to fix me in social time and place and
thus to gauge my biases, the reader is entitled to know a little of
my background. I was born in New York City of academic,
"WASP" parents. I was educated in "eastern" private schools and
an Ivy League college, and I went on to Harvard Medical School,
with the internalized injunctions that to teach and to serve were
good and that business and private practice were bad. Politically,
I believe that the New York Times is the source of truth, and I am a
Republican who votes Democrat. I am divorced, happily remarried, and live in Cambridge, Massachusetts, with my second wife
and four children. I suspect that on the "scales" that I provide of
adult adjustment, defenses, and childhood environment, I fall
about in the middle. As a psychiatrist, I pretend, like so many of
my profession, to belong to no "school," but it may not take the
reader long to realize that I am trained as a psychoanalyst and
am a staunch admirer of Adolf Meyer and Erik Erikson. Less
obvious, but important, I worked for two years in a Skinnerian
laboratory and believe that as a means of uncovering truth the
experimental method is superior to intuition.

Chapter 1
Mental Health
SIR CLAUDE: If you haven't the strength to
impose your own terms upon life, you must
accept the terms it offers you.

- T. S. Eliot, The Confidential Clerk

11 That is mental health?

VV

I submit that health is adaptation, and adaptation is
quite the opposite of the quote from Mr. Eliot. If you have not the
strength to accept the terms life offers you, you must, in selfdefense, force your own terms upon it. If either you or your environment is distorted too much in the process, your effort at adaptation may be labeled mental illness.
This book will examine specific ways in which men alter themselves and the world around them in order to adapt to life. The
examples will be concrete; and, as I have indicated in the introduction, they will be drawn from the lives of men specifically
selected because they demonstrate psychological health. (The absence of women in the Grant Study was an unforgivable omission, and an omission that will require another study to correct.)
Since good psychological health becomes apparent only when the
going gets tough, this book will focus on the difficulties that these
men encountered. The terms adaptation and defense will be used
interchangeably.
At the start, it is important to note that the ways in which
people adapt to help themselves are quite distinct from the ways
in which they conventionally receive help from others. A guiding
clinical principle of Dr. Arlie Bock, the physician who conceived
the Study on which this book is based, was that people in trouble
need to be offered "a leg up" - assistance from others. Yet, in
order to study health, Dr. Bock directed that the college sophomores selected for study be chosen for each man's capacity for
self-reliance.
13

14

The Study

of Mental Health: Methods

and Illustrations

In a crisis, everyone may turn to friends, parents, teachers, or
physicians for help. A child falls down in the park and cuts his
knee. Hearing his cries, his mother picks him up, comforts him,
and bandages his cut. His mother has given him "a leg up," and
the terms life offers are accepted by him. Assisted by others, his
unconscious ego has not needed to come to his aid.
But however valuable the help of others may be, there is much
that humans must do for themselves. Consider the child's involuntary cries that brought his mother running, or the bloodclotting mechanisms that sealed his wound. These were ways
that he took care of himself. Choosing a more complex example,
consider that a broken love affair may lead one man to write
great poetry and another to commit suicide. Both responses represent adaptive efforts on the part of the individual to alter pain
so that it may be borne. Yet neither process is under anything like
full conscious control.
Since most people consider writing good poetry to be healthy
and suicide to be sick, it is tempting at this point to try to define
mental health. But wait. Terms like "health" and "sickness" are
merely useful abstractions. Although I use them in discussing
adaptation, the reader will not always agree with my definitions.
On the one hand, imaginary physical illness may lead to real
hypochondriacal invalidism. Is such an individual sick or well?
On the other hand, as in the case of Teddy Roosevelt's real
asthma, John Kennedy's tangible back injury, and Franklin
Roosevelt's crippling polio, serious physical illness may contribute to mastery of life. Thus, inner processes can either erase or
magnify the effects of external illness. Health and the "ego" must
be considered together.
But already the reader may be startled and mistrustful. As soon
as the names of public figures are mentioned in such a context,
the issue of the author's values arises. In our hearts, we each
claim a special insight into the question "What is health?" If the
reader sees Teddy Rooseve

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